The Agony of Ecstasy

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The Agony of Ecstasy

What goes up, must come down, and when you're talking about the mood-altering drug ecstasy, the "down" can last a lifetime.

Dr. Steven Kish of the Center for Addiction and Mental Health in Toronto compared the brain tissue of a 26-year-old chronic ecstasy user who'd overdosed with 11 non-drug users. Roughly 50 to 80 percent of the neurotransmitter known as serotonin in the overdose victim's brain was depleted, Kish found. No noticeable decreases were found in the control group.

"This is the first study to show that this drug can deplete the level of serotonin in humans," Kish said. About 15 human studies have found that cognition was reduced with use of the drug, although serotonin was not one of the substances mentioned, he said.

Serotonin is an important neurotransmitter responsible for regulating mood, usually for the better, and controlling some thought processes.

Ecstasy is considered an "empathic" drug, with users reporting a heightened sense of euphoria and desire to socialize. But when the serotonin runs out, depression sets in. Cognition, thought processes including memory, pain perception, sleep, and appetite all are affected.

The medical word for ecstasy, methylenedioxymethamphetamine, or MDMA, is structurally related to the hallucinogen mescaline and the stimulant amphetamine. Antidepressants act on the serotonin system to elevate lower amounts of serotonin in depressed people.

"This probably explains why ecstasy users are depressed or unhappy the day after they use it," Kish said.

In Kish's study, the serotonin depletion was sometimes reversible, but sometimes permanent damage was observed, depending on which area of the brain was being scrutinized. He cautioned that more research is needed, since "we can make no statement on brain damage."

The study is significant because it conclusively points to consequences in the human brain -– a toll that drug educators can use when speaking at schools, said researcher Karen Borell of John Hopkins University. "I think it holds promise for prevention. It seems to be the No. 1 drug of choice, especially among the younger population," she said.

As Kish stated in the latest issue of Neurology, "We recognize that conclusions based on a single case can only be tentative. However, our limited data suggest that depletion of serotonin might occur in the brain of some users of the drug and therefore therapeutic efforts to normalize levels of the neurotransmitter might address some of the behavioral problems occurring during drug withdrawal."

The mother of Joe Stephens, the man whose brain was autopsied for Kish's study, said the problem is, "The kids will admit that after a weekend of using ecstasy they are depressed but they don't put it together with the ecstasy."

Tinker Cooper, of Orlando, Florida found the body of her son in 1996. She now belongs to the group Families Against Drugs.

"Not only does it damage cells, it produces functional consequences, including a decline in your memory performance," Borell said, adding that psychiatric conditions such as depression and sleep disturbances almost always set in.

Borell calls ecstasy the "up-and-coming drug" worldwide: 2.3 percent of college students and 4.3 percent of people ages 19 to 28 reported using it at least once in the last year. Overall, 3.4 million Americans at least 12 years old had used ecstasy at least once during their lifetime, according to the 1998 National Household Survey on Drug Abuse survey.

In Toronto, an average of one ecstasy-related death is now reported per month, Kish said. This is up from zero deaths per month in 1997. Forty percent of the deaths in Toronto result from use at rave clubs. "We have a terrible problem with ecstasy use here," he said.

Emergency room visits and mortality rates are hard to measure, Borell said. "Things that go along with taking the drug, not the drug itself, causes the overdose. Dehydration seems to be the No. 1 complication, at least at rave clubs."

Cooper stressed that the answer is not shutting down all raves. "It's a double-edged sword. Cops keep trying to close them down but the clubs will just go underground, they'll go in the woods." At least the clubs keep users visible in the event of an overdose, she said.